- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.20 / $256.75 / $469.62
| Professional | | $166.20 | $256.75 | $469.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.43 / $260.55 / $474.33
| Professional | | $174.43 | $260.55 | $474.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.74 / $327.80 / $592.54
| Professional | | $200.74 | $327.80 | $592.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.66 / $319.39 / $659.63
| Professional | | $208.66 | $319.39 | $659.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.31 / $310.31 / $474.91
| Professional | | $310.31 | $310.31 | $474.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.28 / $356.84 / $614.60
| Professional | | $242.28 | $356.84 | $614.60 |